ABSTRACT
The main purpose of the study was to examine the maternal
and perinatal contributing factors of congenital abnormalities in children
below five years. The study was carried out at the Korle bu Teaching Hospital
in the Accra Metropolis. This study was an exploratory study which used
quantitative method. The participants for the study were selected using
convenience sampling. One hundred and eighty one questionnaires were
distributed to mothers of children with congenital abnormalities who were below
five years at the hospital. The data collected was coded and analyzed using the
Statistical Package for Social Sciences (SPSS). Findings from the study
suggested that, maternal and perinatal contributing factors including illicit
drug use and herbal medication have a very significant and negative influence on
the unborn child. Factors such as regular attendance to antennal clinic,
healthy nutrition and taking of prescribed medication at the clinic also have
significant and positive contribution to the good health of the baby. The study
recommended that mothers should be encouraged to attend antenatal clinics
regularly during pregnancy and health facilities should screen all pregnant
women for congenital malformations for early detection and management. The
psychological impact of congenital abnormalities on the family and educational
programs can be organized to create awareness on the various types of
congenital abnormalities and their management. It is anticipated that if these
measures are taken into consideration, it will help to create awareness of
congenital abnormalities, strengthen existing management procedures and help to
reduce child morbidity and mortality in Ghana.
CHAPTER ONE
INTRODUCTION
Background to the Study
Pregnancy is not just a matter of waiting to give birth (WHO,
2005), but often a defining phase in a woman’s life to be happy and fulfilled
as an individual living in the society (United Nations Development Programme
[UNDP], 2010). According to the WHO (2005), the expectation and hope of every
pregnant woman is to deliver a healthy baby without any complication or defects
before, during and at the end of the pregnancy. Studies have shown that when a
mother gives birth with complications or defects, it generates feelings of
pain, despair, grief and anxiety (Taksande, Vilhekar, Chaturvedi & Jain,
2010; Christianson, Howson & Modell, 2009). Often than not, antenatal care
is to detect, prevent and treat conditions or defects that threaten the health
of the fetus (new born) and/or the mother, and to help women approach pregnancy
and birth with positive experiences.
However, Taksande et al. (2010) opined that there were some
hidden defects that may not surface during antenatal until later years of
development. Congenital anomaly is any morphological, functional, biochemical
or molecular defects that may develop in the embryo and fetus from conception
until birth or at birth (WHO, 2000). The impact of defects on the fetus and
newborn infants is great as they are responsible for 495,000 deaths worldwide
(Eurocat Working Group, 2011 According to the WHO (2012), major causes of these
defects are congenital in nature.). To the Eurocat, many nurse researchers and
theorists were in agreement that majority of these deaths occurred during
the first year of life of these infants and thus, the main reason for the
infant mortality rate in 2011(Alfaro-LeFevre, 2010, Berman & Snyder, 2012).
Congenital anomalies can be caused by single gene defects,
chromosomal disorders, multi-factorial inheritance, environmental teratogens
and micronutrient deficiencies. Congenital anomalies are important causes of
infant and childhood deaths, chronic illness and disability. An estimated 303
000 newborns die within 4 weeks of birth every year, worldwide, due to
congenital anomalies. Congenital anomalies can contribute to long-term
disability, which may have significant impacts on individuals, families,
health-care systems, and societies (WHO, 2016). The most common, severe
congenital anomalies are heart defects, neural tube defects and Down syndrome.
Although congenital anomalies may be the result of one or more genetic,
infectious, nutritional or environmental factors, it is often difficult to
identify the exact causes. Some congenital anomalies can be prevented.
Vaccination, adequate intake of folic acid or iodine through fortification of
staple foods or supplementation, and adequate antenatal care are just examples
of prevention methods.
Ramagopalan et al. (2005); and Arnold and Christopher (2006)
identified the most common body systems involved in congenital anomalies to
include musculoskeletal, central nervous system, gastro intestinal system and
cardiovascular system with the least affected system being the urogenital
system. Congenital anomalies have emerged as the major childhood health
problem, affecting approximately 1 in every 33 infants and are the fourth most
common cause of neonatal deaths in Africa. It is also the leading
cause of about 3.2 million birth defect-related disabilities every year (WHO,
2012).
Many people who are ignorant about this condition tend to
associate the phenomenon with several misconceptions. According to Nyasor
(2012) most Africans believed that the possible causes of their children’s
condition have spiritual dimensions; gods on a visit. This intends influence
most parents to shirk their responsibilities of providing the financial means
to seek for the needed treatment for the child. Jowi (2013) had similar view
with parents that congenital abnormality is a strain on child-parent relation,
family routines and also other siblings in the family. Parents often fear to
disclose their child’s condition to friends and relatives because they have
experienced a sense of shame, self-blame and rejection. They consequently
withdraw from their relatives and social circle.
Statement of the Problem
The prevalence of congenital abnormities worldwide is estimated
at 3-7%, but actual numbers vary widely between countries (Singh & Gupta,
2009; UNDP, 2010). For instance, in the United States and Canada where
congenital anomalies are diagnosed intra uterine and aborted, the prevalence is
estimated to be around 2-2.5% of all live births (Perinatal Health Report,
2002; Sekhobo & Druschel, 2001). However, in Asia, African and other
developing countries the magnitude and incidence of congenital anomalies varies
from 2.5% to 20% of infants at birth (Shawky and Sadik, 2011). For instance, in
the studies of Shawky and Sadik (2011) it is reported that the prevalence of
this anomaly is around 2.5% in India, about 11.4% in Pakistan, around 16% to
20% in African and West Africa. Ghana is no exception to these findings as in 2010, the prevalence
rate of neurological cases of 1.8% was recorded in the three northern regions,
sidelining the unreported cases at health centers (Korle-Bu Hospital, 2013).
Some studies have shown that there are some predisposing
factors to congenital anomaly, such that exposure to these factors makes this
anomaly likely (Ekwere, Meneil, Agim & Jeminiwa, 2011; Taksande et al.,
2010). According to UNDP (2010); WHO (2000); and Berman and Snyder (2012) predisposing
factors include exposure to X-ray, alcohol and substance abuse, single gene
defects, chromosomal disorders, multifactorial inheritance, environmental
teratogens and micronutrient deficiencies. It has also been proved that this
anomaly has caused the death of new born. Eurocat Working Group (2011)
mentioned that the impact of defects on the fetus and newborn infants is great
as they are responsible for 495,000 deaths worldwide. Knowledge and medical
improvement is one way of minimizing or reducing the burden on the incidences
of congenital abnormality.
Though, there is the recognition of the critical need to
promote awareness of the diseases, very little has been done in terms of
research work in Ghana and other developing countries (WHO, 2012). Additionally,
literature on contributing and possible risk factors for congenital abnormality
in Africa and for that matter, Ghana, is limited. Also, with the high index of
suspicion based primarily on a careful family and maternal history, the
understanding of the numerous causative factors are important in identifying
congenital abnormalities, many of which can be detected only if one is
searching for them. This study will therefore seek to investigate the maternal
and perinatal risk factors of congenital abnormalities in children under five years at the Child Health Department,
Korle-Bu Teaching Hospital.
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